Samantha Gregory Dagenhardt, RN, MS, MSN, PMHCNS-

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4747-33 Issued in WI

Practice address

121 W Main St
Port Washington, WI 53074-1813

Phone

(262) 284-8157

Fax

(262) 284-8209

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

County of OzaukeeGroup PAC ID 5698737450, 5 clinicians

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Master of Science - Nursing, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group NPD
• County of Ozaukee

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Washington, WI
  • NPI 1609867001
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• County of Ozaukee

  • Public Health or Welfare Agency
  • Port Washington, WI
  • NPI 1740475250
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Columbia St. Mary'S Hospital Milwaukee, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1871656082
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1659642841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W MAIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741813",
            "telephone_number": "262-284-8200",
            "fax_number": "262-284-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W MAIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741813",
            "telephone_number": "262-284-8157",
            "fax_number": "262-284-8209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 Dewey Ave",
            "address_purpose": "LOCATION",
            "city": "Wauwatosa",
            "state": "WI",
            "postal_code": "532132504",
            "country_code": "US",
            "telephone_number": "414-454-6566",
            "fax_number": "414-454-6522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAGENHARDT",
        "first_name": "SAMANTHA",
        "middle_name": "GREGORY",
        "credential": "RN, MS, MSN, PMHCNS-",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2023-03-07",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4747-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "4747-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "170792-30",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APNP",
            "identifier": "4747-33",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659642841",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100028338",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdagenhardt60909@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1220 Dewey Ave",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532132504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1220 Dewey Ave",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532132504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• County of Ozaukee
• County of Ozaukee
• William A Covelli, DDS
• Courtney Jory Cowen
• Ella Cox
• Angela T.M Damrow, PTA
• Susan Ann Dobberpuhl, OTR
• Kaylee Doll
• James Aaron Doyle, MSHA, ABOC
• Marcy Drummy, MS, LPC

• Psychiatric/Mental Health Nurse Practitioner in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.